Chinese exploration of BTKi, rituximab, and lenalidomide in the treatment of DLBCL

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, and its incidence increases with age, particularly in adults ≥ 75 years, with 28.

In recent years, an increasing number of non-cytotoxic drugs have been applied to DLBCL patients, including BTK inhibitors and lenalidomide
.

Recently, Chinese scholars have published two IR2-like protocols (ibratinib + rituximab + lenalidomide, or BTKi + rituximab + lenalidomide) to treat elderly patients with unfit DLBCL, which are shared below
.

The treatment of IR2 regimen ≥ a Phase 2 study of the initial treatment of DLBCL at the age of 75

The team of Professor Zhao Weizhen of Ruijin Hospital conducted a single-center Phase II clinical study, and a total of 30 patients aged
≥75 years old, unfit/frail, and first-treatment DLBCL were enrolled from May 15, 2019 to May 8, 2020.

The median age of patients was 80 years, compared with 20 (67%) The age of patients ≥ 80 years
.

The CRR was 56.

The main grade 3 to 4 hematologic adverse effects during treatment are a decrease in neutrophil count (23%), a decrease in the platelet count (10%), and anemia (7%)
.

Real-world studies of BTKi, rituximab, lenalidomide for the treatment of the elderly, or unfit DLBCL

Professor Jin Jie and Professor Yu Wenjuan of the First School of Zhejiang University led a real-world single-center study recently published in Experimental Hematology & Oncology, which further confirmed the efficacy
of ibratinib/zebutinib/obupinib + rituximab + lenalidomide (i.

The center enrolled 31 patients from October 2019 to November 2021 and were treated
with a SMART (n=17) or SMART-START (n=14) regimen.

The median age of patients was 75 years, with the average age (82 years) in the SMART group and 67 years in
the SMART-START group.

In the SMART group, 6 patients received ibretinib, 9 patients received zebutinib, and 2 patients received obrotinib; In the SMART–START group, 10 patients received ibretinib, 2 patients received zebutinib, 2 patients received obupinib, 7 received R-CHOP in chemotherapy, 3 received R-DAEPOCH due to double expression, and 3 received R-Gemox/R-miniCHOP
.

Among the patients who could be evaluated, the ORR in the SMART group was 87.

Median follow-up was 15.

The most common 3-4 AE is neutropenia (8/31
).

This study shows that the SMART regimen is a good first-line treatment option for older DLBCL patients, well tolerated and effective, and that the SMART-START regimen is safe and effective
in unfit patients who cannot tolerate standard R-CHOP at the time of diagnosis.

References

1.

2.
Yanan Zhu, Xiang Zhang, Juying Wei,et al.
Rituximab, lenalidomide and BTK inhibitor as frontline treatment for elderly or unfit patients with diffuse large B-cell lymphoma: a real-world analysis of single center.
Exp Hematol Oncol .
2022 Sep 16; 11(1):57.
doi: 10.
1186/s40164-022-00314-w.

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